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Books 2009: 76

non-fiction


76. Guido Majno, M.D., The Healing Hand: Man and Wound in the Ancient World, Harvard, 1975.

This is a really interesting book. It deals with ancient medicine in Mesopotamia, Egypt, Greece, Alexandria, India, China and Rome.

It's not exhaustive, and Majno's offhand comments about the historical contexts make it obvious he's not primarily an ancient historian. However. As an introduction to ancient medicine, I can't imagine a better book. It talks both about the theories behind the medicine of the times, and about the techniques of that medicine.

Surgery. Operations to drain pus from the chest cavity. (Empyema: so much pus in the pleural cavity that a fistula appears between the ribs.) Infected bone. Theories of inflammation. Wound dressings, and how likely were you to be helped, rather than hurt, by an ancient physician? Removal of arrows. Sutures, and whether or not they were likely to suppurate and fall out.

And what happens if you get hit on the head? Majno writes:

"To the iatrós [the Greek surgeon], the preliminary probing is essential. If there is a fracture, he will not operate further; if there is no fracture, he will drill a hole in the skull; and if the is just a hedra [a dent], he will scrape it away. Here he runs into a diagnostic problem: how is he going to distinguish a thin crack from a normal joint between two bones?

"The answer... First he shaves the head. Then he enlarges the wound, lifts the scalp all around it, and packs the space with lint. Then he plugs the wound itself with a plaster made by boiling vinegar and barlley flour, and covers the whole with a bandage. That is all for the day. The next day he removes everything, smears the skull with something that looks like black shoe polish, and covers it again with oil, linen, and more barley plaster. The third day he scrapes the blackened skull with a sharp knife: experience has shown him that the black will come off everywhere except from cracks and dents. He goes on scraping until all the black is gone. To the Hippocratics this horrible procedure was very important."

And of osteomyelitis:

"Patches of bare bone, exposed by infection, were so common they had a special name, now forgotten: psíloma, 'a bareness'."

He quotes from Epidemics VII:

"Trepanation brought out of the bone itself a thin ichor, serous, yellowish, stinking, deadly. In such cases vomiting may also occur, and spasms towards the end, and sometimes loud cries, and sometimes paralysis...

"The child of Theodoros exposed himself to the sun on the ninth day. Fever came on the tenth day from a bareness of the bone which was, as one might say, nothing at all. During the fever the part became livid, the skin came off; many loud cries; on the twenty-second day the belly swelled up, especially toward the hypochondria; on the twenty-third he died...

"The child of Isagoras was wounded in the back of the head, the one was injured and became livid on the fifth day. He was healed, and the bone did not slough off...

"At Cardias, the son of Metrodoros, after a toothache, had gangrene of the jaw; terrible overgrowth of flesh on his gums; he gave a moderate amount of pus; the molar teeth and the jaw fell out."

Yep. Definitely an interesting book, with descriptions of the dressings - if you had a honey and resin dressing, or one with honey and copper verdigris, you might be okay: sheep's fat and dove's droppings, not so much. Majno also descibes experiments on the antibacterial properties of various of the treatments - honey, vinegar, wine: altogether useful.

Recommended, but not if you have a weak stomach.

Date: 2009-09-21 02:57 pm (UTC)
From: [identity profile] etumukutenyak.livejournal.com
serous, yellowish, stinking

That's a classic indication of an infection.

Trepanation (or trephination) is not (in and of itself) fatal, but a careless surgeon can cause more problems. Honey, vinegar, and wine are excellent antiseptics if you don't have any chlorine solution. ;-)

Date: 2009-09-21 03:59 pm (UTC)
From: [identity profile] hawkwing-lb.livejournal.com
Well, definitely not pus bonum et laudibile.

Considering that surgeons and physicians didn't understand either the circulation of the blood or the causes of inflammation, it's a wonder that anyone who was injured ever survived treatment.

Date: 2009-09-21 04:27 pm (UTC)
From: [identity profile] etumukutenyak.livejournal.com
Well, to be fair, they got the concept that releasing pus was laudable, only not the reasons why.

Doing "no harm" is easier and yet more difficult than it sounds. Most of us will heal in a decent manner, given enough support; we just like to push the limits of "enough support" and include the previously-fatal injuries as "now survivable". Also, when motivated, people demonstrate the ability to utilize scientific reasoning skills even when not highly trained scientists -- as indicated by all the ancient texts on using willow bark for fever and honey for open wounds.

Date: 2009-09-22 12:52 pm (UTC)
From: [identity profile] hawkwing-lb.livejournal.com
Well, eventually they figured some things out.

But I am glad I have modern medical care. Especially today. *sneezes*

Date: 2009-09-22 04:49 pm (UTC)
From: [identity profile] etumukutenyak.livejournal.com
::disinfects keyboard, just in case::

Oh, yes, and someday our progress will be our descendants horror. ;-)

::leaves pot of hot water, honey, and lemons by the door::

Date: 2009-09-22 04:50 pm (UTC)
From: [identity profile] etumukutenyak.livejournal.com
'

Here's that errant apostrophe that went running from the previous post.

Date: 2009-09-22 08:38 pm (UTC)
From: [identity profile] hawkwing-lb.livejournal.com
Yes, no doubt in five hundred years civilisation will look back and say, "Yikes!"

The old-fashioned diet of 7-Up, cough sweets, soup and whodunnits appears to be working in some measure. :)

Date: 2009-09-22 10:41 pm (UTC)
From: [identity profile] etumukutenyak.livejournal.com
Ah, yes; the clear liquid and mystery diet. You have balanced your bilious humours with 7-Up, and your choleric with whodunnits. ;-)

Date: 2009-09-23 11:23 am (UTC)
From: [identity profile] hawkwing-lb.livejournal.com
But what about my phlegmatic humours? 'Cause I'm full of them. :P

Date: 2009-09-23 03:26 pm (UTC)
From: [identity profile] etumukutenyak.livejournal.com
There's your problem, then. Not enough soup!

Date: 2009-09-23 05:21 pm (UTC)

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